Graduate-level pathophysiology demands integration of complex biological concepts, yet many students struggle to move beyond memorization and often default to passive review methods. This study aimed to evaluate the impact of a structured post-exam reflection activity on metacognition and study strategy awareness among graduate nursing students enrolled in an advanced pathophysiology course. We hypothesized that implementing a reflective post-exam activity would improve students’ self-awareness and utilization of effective study habits and test-taking strategies to support content mastery. The intervention was introduced in a graduate-level pathophysiology course enrolling approximately 200 students. Following each exam, students scoring below 80% were invited to complete a structured reflection via the online learning platform. The reflection prompted analysis of missed questions, identification of current study strategies, and planning for alternative approaches. Faculty provided individualized feedback and evidence-based recommendations. Participation was voluntary and non-punitive. Approximately 50% of students were assigned at least one reflection. The majority of assigned students completed the reflection. Commonly reported ineffective strategies included passive review and a lack of spaced repetition. Faculty feedback emphasized active recall, concept mapping, and teach-back methods. Students who completed reflections demonstrated an average improvement of 10 percentage points on subsequent exams. Qualitative feedback indicated increased metacognitive awareness and appreciation for faculty engagement. In conclusion, incorporating structured post-exam reflections in graduate nursing education promotes metacognition and encourages adoption of effective study strategies, contributing to enhanced content mastery, improved academic performance, and overall student success. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.
Mackos et al. (Fri,) studied this question.